ANAON THE FRONTLINE Safe patient handoffs - n Academic incivility n Conference preview n Gallup: Nurses #1 - American Nurse Today
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ANAON THE FRONTLINE NEWS FROM THE AMERICAN NURSES ASSOCIATION
Safe patient handoffs
n Academic incivility n Conference preview n Gallup: Nurses #1
January 2019 American Nurse Today 27
Patient Safety
Consistent, quality communication
Nurses help lead efforts on safe patient handoffs and transfers
By Susan Trossman, RN
Note: This is the first of two articles in a series look-
ing at nurses’ contributions in addressing patient
safety.
T
he number of patient handoffs that take place
every day in healthcare settings across the
country is immense. Making sure that every
handoff, from admission to discharge, is accom-
plished perfectly may seem like an insurmountable
task. Yet nurses are among those who continue to
strive to develop protocols and tools to ensure that
every patient handoff and transfer is a safe one.
Routine, but not
“While it sounds simple, a high-quality handoff is
complex,” noted The Joint Commission in a Sep-
tember 12, 2017, Sentinel Event Alert. The commis- One ED’s solution
sion described communication issues as a common
“In the past, handoff reports to inpatient nurses were
problem in handoffs. Specifically, “expectations can
very inconsistent,” said Amy Scott, MSN, RN, CPN,
be out of balance” between the person providing
the clinical information and the receiving caregiver. quality improvement program coordinator, emergen-
And inadequate information or miscommunication cy department, Children’s Mercy Kansas City. “Nurses
around handoffs contributes to sentinel and other in the ED told nurses on inpatient units what they felt
adverse events. was important. And if patients
weren’t critically sick, a tech ac-
The commission initially addressed handoff com- companied them to their new room.
munication in a National Patient Safety Goal in As a result, nursing staff on the in-
2006, and 4 years later made it a standard. Yet the patient units often said that they
problem of inadequate handoff communication didn’t feel as if they had enough
persists, prompting the commission to issue the knowledge about the patient and
alert along with strategies to ensure successful pa- what had been done in the ED.
tient care transfers. “Nurses in the ED also were playing
“Effective patient handoffs are an important aspect a lot of phone tag to see if beds on
of patient safety, and we can be doing a better the units were available, which Amy Scott
job,” said Justin Winger, PhD, RN, who served as took time away from patient care.”
chair of a 2017 committee reviewing the Emergen- To bolster patient safety, Scott and a team of nurses
cy Nurses Association’s (ENA’s) position statement worked to develop and implement a standardized
on patient transfers and handoffs. ENA is an orga- patient handoff tool and process, which included RN-
nizational affiliate of the American Nurses Associa- to-RN, face-to-face reporting at the patient bedside
tion (ANA). for ED-to-inpatient transfers. (The team included
Most nurses pay very close attention when admin- nurses from the ED and inpatient units, where RN-to-
istering medications because the potential for mak- RN bedside reporting was initiated the previous
ing a serious error has been ingrained in them since year.) The goal was to have the new process up and
school, Winger said. Traditionally, however, nurses— running by March 2017. Training materials and videos
and others—haven’t placed patient handoffs in the also were created to help staff learn the process.
same category of concern, so reporting off to the
The first critical component is called PITCH, which
next care provider is done almost by rote.
stands for pre-inpatient telephone call handoff. The
Winger said effective patient handoffs are a partic- RN from the ED calls the appropriate inpatient unit
ularly salient issue in emergency departments to speak to an RN, which doesn’t have to be the one
(EDs) because they occur so often and between taking the patient, so they can prepare the room.
different levels of providers, including emergency Basic patient information also is provided, such as
medical technicians and nurses. name, age, diagnosis, language needs, if the patient
28 American Nurse Today Volume 14, Number 1
must be on oxygen or in isolation, and social con- This safety initiative was shared during a poster
cerns. At that point, the communicating RNs deter- session at the 2018 ANA Quality and Innovation
mine a time for the patient transfer, whether the pa- Conference.
tient will be brought to the unit or picked up at the
ED, and the mode of transportation, such as wheel- Easy as 1, 2, 3
chair, wagon, or bed.
Making sure patient flow actually flows—and with
When the patient is transitioning from the ED to the seamless provision of care—can be a persistent prob-
inpatient setting, the face-to-face, RN-to-RN report is lem. However, through an innovative project, Heather
given at the patient bedside either in the ED or on Runnels, MSN, RN, CRRN, and an interdisciplinary
the inpatient unit. team discovered a
“Nurses go through solution that’s aimed
a standardized pro- at making patient
cess when giving admissions and inpa-
their reports, and tient and ED trans-
provide patient in- fers more efficient
formation in a set se- and safer for pa-
quence,” said Scott, tients, physicians,
a Missouri Nurses and nurses.
Association member. The project was initi-
The report starts ated after communi-
with an introduction ty physicians ex-
of the patient and pressed difficulty
family members to directly admitting
the inpatient nurse patients into Our La-
and verification of dy of the Lake Re-
the patient’s name gional Medical Cen-
and any allergies. It ter in Baton Rouge,
also covers diagno- LA, according to
sis, previous medical Runnels, senior di-
history, vital signs, “Patients feel safer because they don’t feel like rector of nursing for
pain score, and the patient care services.
they are lost in the cracks. And the biggest
ED nurse’s focused As Runnels and her
assessment of the rel- takeaway has been improved communication,
team began system-
evant patient system. including during patient handoffs.” atically examining
The ED nurse then — Heather Runnels their facility’s current
logs into the comput- process of managing
er, reviews the orders patient admissions
and the medication administration record, and looks and transfers, they realized it was cumbersome and
for outstanding consults. Together, the nurses check inefficient, leading to delays in care and impacting
the I.V. site and rates, and any wounds. The family patient outcomes.
then is asked if information was left out and if they
have questions. “We wanted an ‘easy’ button,” said Runnels about
finding an enhanced way that clinicians and patients
“The inpatient unit nurses feel they get much better experience the admitting and transfer process. Their
reports now,” Scott said. “It’s not only more informa- solution was to develop a centralized patient referral
tion, but the necessary information that allows us to center, which would serve as the portal
give the best care to our patients.” for all patient flow, and a new pro-
Nurses and families both have responded positively cess. Physicians were provided with
to the standardized patient handoffs, according to education on the new, three-step
Scott. They had 90% compliance 120 days after the model for direct admissions, which
tool and process were implemented. Additionally, started with a call to the patient
the collaborative approach helps nurses from the referral center. Nurses and other key
ED and inpatient units better understand each oth- staff also learned the process and
er’s clinical approaches and assessments in meeting model.
patients’ needs.
After calling the referral center, a clinical access
Scott and the team members, however, continue to nurse completes the initial patient intake process,
meet to address some of the “pain points,” such as such as addressing physician admitting orders and
patient handoffs around shift change and having lab work, and then hands off the patient to a receiv-
enough transport equipment. ing nurse on the newly created express admission
January 2019 American Nurse Today 29
unit. There, fully seasoned nurses perform a head-to-
toe admission assessment and begin implementing
the plan of care, such as administering medications,
among other interventions, according to Runnels, a
Louisiana State Nurses Association member.
The express admission unit is located in a former
intensive care unit with an open, bullpen design,
which allows nurses to easily watch patients for any
status changes that may necessitate transferring
them sooner or to a higher level of care. The average
length of stay on the unit is about 1 hour, Runnels
said.
When a bed on the appropriate unit is available, the
express admission nurse provides a detailed report
to the receiving, inpatient unit nurse, who no longer
has to take on the extra work of handling a compre-
hensive patient admission on top of an existing pa-
tient-load.
“We want to make sure all nurses have the informa-
tion they need and are on the same page,” Runnels
said.
“Patients feel safer because they don’t feel like they
Hand-off reports are given in a standard manner are lost in the cracks,” Runnels said. “And the big-
across the hospital, using BSAP (background, situa- gest takeaway has been improved communication,
tion, assessment, plan), according to Runnels. The including during patient handoffs. Response has
patient’s history is given, current acute medical been nothing but positive from nurses receiving pa-
problems are discussed, and the patient’s vital signs, tients on their units since this process has been put
intake and output, and review of systems assess- into place.”
ment performed by the nurse are relayed along with
the initial plan of care. Final thoughts
Since the referral center and new process began in Winger said that implementing a standardized com-
April 2017, Runnels said patient safety has improved. munication approach during handoffs—including
(A poster presentation on this effort was shared those aided by mnemonics like I-PASS (illness se-
widely at the ANA conference.) verity, patient summary, action list, situation aware-
ness and contingency planning, synthesis by receiv-
er) and SBAR (situation, background, assessment,
recommendation)—is vital. That point is emphasized
in the ENA position statement, which also notes
that caregivers involved in patient handoffs have
different levels of knowledge, skills, and clinical
judgment.
“Nurses should work with their facilities to pick a
format that allows for all the pertinent patient infor-
mation to be conveyed accurately,” Winger said. “If
vital information is lost, patient safety is an issue.”
— Susan Trossman is a writer-editor at ANA.
Resources
The Joint Commission Sentinel Event Alert:
jointcommission.org/assets/1/18/SEA_58_Hand_
off_Comms_9_6_17_FINAL_(1).pdf
Emergency Nurses Association position statement:
ena.org/docs/default-source/resource-library/
practice-resources/position-statements/patient
handofftransfer.pdf?sfvrsn=e2c42cb6_10
30 American Nurse Today Volume 14, Number 1
From the Ethics Inbox
Coping with incivility in academia
To: Ethics Advisory Board Many authors have written on best practices to deal
with student issues and how to apply the Code of
From: Disappointed nursing professor
Ethics for Nurses with Interpretive Statements (nurs-
Subject: Bullied by peers ingworld.org/code-of-ethics) to the faculty-student
I
am a new assistant professor at a university, after relationship, but how often do nurse educators and
12 years in my previous academic position. I was their nurse supervisors in academic positions view
excited to become part of the faculty but have al- their incivility toward faculty peers and co-workers
ready encountered my peers calling me derogatory through the lens of the Code?
terms, telling me that I will not survive in the environ-
The nurse educator is first and foremost a nurse.
ment, and one faculty member actually pushing me
Nurses, including nurse educators, are expected to
out of her way during a faculty meeting. We are sup-
posed to set an example for students, yet the bully- incorporate ethical practice in their personal defini-
ing and incivility amongst ourselves is unimaginable. tion of what it means to be a nurse. In the Code, the
Please help. term “practice” refers to the “actions of the nurse in
any role or in any setting.” Incivility perpetrated by a
nurse educator toward another nurse educator in any
form at any time is unethical and unprofessional be-
havior. The Code obligates nurse administrators and
educators in academia to “create an ethical environ-
ment and culture of civility and kindness, treating
colleagues, coworkers, employees, students, and oth-
ers with dignity and respect.”
An effective way to reduce the physical and emo-
tional costs that come with incivility in a nursing col-
lege is to create a culture that refuses to tolerate
nurses’ behavior that consistently undermines their
peers and violates the Code. As a nurse educator,
you should not be afraid to report incivility up the
chain of command and have confidence in leadership
that your concerns will be addressed in an ethical
and fair manner. Management expert Christine Po-
rath’s suggestion for nurse educators who find them-
selves in a toxic environment is to work to improve
your well-being in the office rather than trying to
change the perpetrator(s), the toxic leader, or the
caustic work relationship. This is often the most ef-
fective remedy for incivility.
If a nurse educator cannot ethically practice nursing
with integrity and authenticity in an academic set-
From: ANA Center for Ethics and Human Rights ting, he or she may need to leave the job. A strong
I am saddened to hear about your experience as a moral compass and guidance from the Code will help
new faculty member. Incivility and toxicity in the you make an ethically reasoned choice.
workplace can exact a steep toll personally and pro-
fessionally. The American Nurses Association (ANA) — Response by Elizabeth O’Connor Swanson, DNP, MPH,
APRN-BC, member of the ANA Ethics and
defines incivility as “one or more rude, discourteous,
Human Rights Advisory Board
or disrespectful actions that may or may not have a
negative intent behind them,” whereas bullying is
“repeated, unwanted, harmful actions intended to Do you have a question for the Ethics Inbox?
humiliate, offend, and cause distress in the recipi- Submit at ethics@ana.org.
ent.” Cynthia Clark, PhD, RN, ANEF, FAAN, was one
of the first researchers to look at faculty-to-faculty
incivility and noted that “ultimately, incivility is an
Selected references
injurious affront to human dignity, an assault on a Clark CM. National study on faculty-to-faculty incivility:
person’s intrinsic sense of self-worth, and the ef- Strategies to foster collegiality and civility. Nurse Educ.
2013;38(3):98-102.
fects [of this on the individual] can be devastating,
debilitating, and enduring.” Porath C. An antidote to incivility. Harv Bus Rev. 2016;4:108-11.
January 2019 American Nurse Today 31
ANA News
Pathway Conference + Quality and Innovation
T
wo exceptional nursing conferences—American serve. Bailey leverages what he’s
Nurses Credentialing Center (ANCC) Pathway learned in over 30 years of working
to Excellence Conference® and American Nurs- for six different companies, includ-
es Association (ANA) Quality and Innovation Confer- ing the Disney Institute and The
ence—will come together under one roof April 24–26, Ritz-Carlton Learning Institute, to
2019, in Orlando, Florida. For the first time, attendees create moments that matter.
will be able to register for one of these transforma- Robin Farmanfarmaian Brett Culp
tional events and get access to the other for no addi- “The Patient as CEO”
tional cost. This talk examines how the conver-
gence of accelerating technology is
Thousands of attendees can expect to hear from in-
changing healthcare over the next 5
spiring speakers during the general sessions; get
to 10 years and enabling the health-
hands-on experience with new technologies in the
care consumer to be the key deci-
exhibit hall; learn tips and techniques in more than
sionmaker on the healthcare team.
60 concurrent sessions, 300 poster sessions, and 25
Technologies including sensors,
virtual oral sessions; and have access to endless net-
point-of-care diagnostics, 3D print- Simon T. Bailey
working opportunities. The new Nurse Pitch™ com-
ing, sequencing, data, networks,
petition will give entrants the chance to win mone-
cloud, artificial intelligence, and ro-
tary prizes to further develop a winning product.
botics are intersecting healthcare at
General session speakers are: an increasing rate, allowing truly
Brett Culp personalized medicine.
“Superhero Leadership: How Everyday People Can Nick Tasler
Have an Extraordinary Impact” “Mastering Change One Decision at
Culp shares powerful stories from his filmmaking ad- a Time”
ventures of ordinary people who have accomplished We all feel in control of our desti- Robin
extraordinary things. He demonstrates how everyone ny…right up until the department Farmanfarmaian
has the opportunity and capacity to embrace leader- reorganizes, the economy stum-
ship and make an impact. bles, the physician delivers a dis-
turbing diagnosis, or a new technol-
Simon T. Bailey
ogy disrupts our tried-and-true
“Shift Your Brilliance”
business model. In this exciting talk,
If you’re unforgettable, you’ll create a customer for
Tasler will show us how to stop fear-
life—and in this service-driven economy, where auto-
ing change, and start mastering it.
mation and algorithms have replaced personal inter-
action, every moment is an opportunity to create a Learn more and register today at
memory in the hearts and lives of the people you pteqicon.org. Nick Tasler
ANA and HIMSS join forces to advance nurse-led innovation
T
he American Nurses Association (ANA) and nursing-informatics/position-statement) to showcase
HIMSS, a global, cause-based, not-for-profit or- the value in health information technology and health-
ganization focused on better health through in- care settings. ANA collaborates with key partners and
formation and technology, announced a new relation- has established a three-part innovation framework to
ship in December 2018 that aims to drive nurse-led develop skills and build a culture of innovation (nurs-
innovation through co-branded initiatives such as ingworld.org/practice-policy/innovation-evidence).
NursePitch, NurseJam™, and other Innovation Lab
events. The collaboration is a unique opportunity to “Nurses are natural innovators with an unmatched
harness all nurses as innovators, entrepreneurs, and perspective on what works in healthcare, and what
tech enthusiasts. doesn’t work,” said Bonnie Clipper, DNP, RN, MA, MBA,
CENP, FACHE, vice president of innovation at ANA.
The inaugural NursePitch will take place at the HIMSS19 “As the largest group of health professionals and rep-
Global Conference in February 2019, followed by a resenting the frontlines of care, nurses are well-
NursePitch competition at the 2019 ANA Quality and equipped to create and develop innovative solutions
Innovation Conference in April.
to address a complex and ever-changing healthcare
Nurse-led innovation is a priority for both HIMSS and landscape. ANA is thrilled to continue our work and to
ANA. HIMSS has developed the foundation for an en- partner with HIMSS to transform health through
gaged nursing informatics culture (himss.org/library/ nurse-led innovation.”
32 American Nurse Today Volume 14, Number 1
Nurses maintain #1 spot in Gallup’s ethical standards poll
T
he American Nurses Asso- and invaluable,” said past ANA
ciation (ANA), which repre- President Pamela F. Cipriano,
sents the interests of the PhD, RN, NEA-BC, FAAN. “These
nation’s 4 million RNs, extends results are a testament to nurses’
resounding congratulations to impact on our nation.”
nurses for maintaining the #1
According to the poll, 84% of
spot in Gallup’s annual honesty
Americans rated nurses’ honesty
and ethics poll. The American
and ethical standards as “very
public, for the 17th consecutive
high” or “high.” The next closest
year, rated nurses the highest
profession, medical doctors, was
among a host of professionals,
rated 17 percentage points behind nursing.
including police officers, high school teachers, and
pharmacists. “As the largest group of healthcare professionals,
nurses are leaders and change agents from the bed-
“Every day and across every healthcare setting, we
are on the frontlines providing care to millions of peo- side to the boardroom,” Cipriano said.
ple. Nurses’ contributions to healthcare delivery, pub- Read more in ANA news at nursingworld.org/news/
lic health challenges, natural disaster relief efforts, re- news-releases/2018/ana-congratulates-nurses-for-
search, education, and much more, are unmatched maintaining-1-spot--in-gallups-ethical-standards-poll.
ANA call for nominations
The nomination period ends January 15, 2019 at
11:59 pm Eastern Time.
O
n December 7, 2018, the American Nurses As-
sociation (ANA) Nominations and Elections
Committee issued a call for nominations for a
slate of candidates to be presented to the Member- ond Call for Nominations will be conducted for those
ship Assembly in 2019. The following positions will be elective positions with insufficient nominations.
elected in 2019.
Preparation of nomination materials
ANA Board of Directors 1. READ the roles and responsibilities for your posi-
Officers tion of choice to ensure that they match your in-
• Vice president terests, experience, and qualifications.
• Treasurer
2. IDENTIFY the degree to which you possess the
The term of service for both officer positions is competencies that have been deemed important
January 1, 2020 – December 31, 2021. to serve successfully and effectively.
Directors-at-large 3. SELECT a campaign manager, if desired, and pro-
• One director-at-large vide their contact information where requested on
• One director-at-large, recent graduate the online nomination form.
(A recent graduate is one who has graduated 4. COMPLETE AND SIGN/INITIAL where noted.
within 5 years prior to being elected to office.) Nominees for the ANA Board of Directors also
The term of service for both positions is January 1, must submit the following additional documents,
2020 – December 31, 2021. which are included in the online nomination form.
• Conflict of Interest Statement
ANA Nominations and Elections Committee
• Financial Interest Disclosure Form
• Four member positions
5. SUBMIT all nomination components by 11:59 pm
The term of service for all four positions is January 1,
Eastern Time on Tuesday, January 15, 2019.
2020 – December 31, 2021.
Please note:
ANA places high priority on diversity and seeks to • You will need to create a user ID and password
encourage and foster increased involvement of mi- before accessing the form.
norities and staff nurses at the national level. • Nominations that are incomplete, handwritten,
faxed, or submitted after the deadline will not
Nominations must be submitted via the online nomi-
be accepted.
nation form (https://fs30.formsite.com/ANA_Nurs-
ingWorld/Elective-Office/index.html) by 11:59 pm If you have questions about ANA’s nomination pro-
Eastern Time on Tuesday, January 15, 2019. A sec- cess or national elections, please email nec@ana.org.
January 2019 American Nurse Today 33
DonationS at work
It’s easy to make a difference: You can too
D
o you have a cell phone or a birthday?
If so, you can help colleagues and the
community with the press of a button.
Technology makes it simple through text-to-
give and social media giving campaigns that
use the collective power of individuals to cre-
ate an impact for a worthwhile cause.
As the new year begins with a focus on per-
sonal aspirations, consider how you can sup-
port nurses, the profession, and those in
need.
Text-to-give campaign
More than 2,000 nurses participated in a
text-to-give campaign through the Ameri-
Donations from individual conference attendees quickly added up in a
can Nurses Foundation last fall at the 2018
matter of days, raising thousands of dollars for two charitable causes.
American Nurses Credentialing Center Na-
tional Magnet Conference held in Denver,
®
You will receive a confirmation text either asking you
CO. The funds raised supported the health of the to type YES or provide your zip code. Then the con-
Denver community through the local charity select- tribution will be applied to your monthly phone carri-
ed in collaboration with the Magnet co-host hospi- er bill. Note that you must use your personal phone—
tals, Metro Caring, and the health of nurses through most corporate or employer-issued phones prohibit
the Healthy Nurse, Healthy NationTM initiative. contributions by texting.
Social media giving
Nurses everywhere are using their social media plat-
forms to raise money. You can use your birthday or
any milestone to create a personal Facebook fund-
raiser. It’s an easy and fun way to raise funds to help
nurses. Here’s how:
• Log into your Facebook account and click “Fun-
draisers” from the menu on the bottom right.
• Click “Raise Money” and then search for Ameri-
can Nurses Foundation among the “Nonprofit”
options. Pick a goal and an end date (like your
whole birthday month).
• Give your fundraiser a catchy and descriptive ti-
tle and use your summary to explain why you
think your Facebook friends should support
nurses through the Foundation. Click “Get
Attendees at the 2018 Magnet Conference generously texted Started” to make your fundraiser page available
their support for Metro Caring, a Denver Charity, and for everyone to see.
Healthy Nurse, Healthy NationTM.
Then spread the word—inviting all of your friends to
Nurses from across the globe texted their support, participate will maximize your outreach and so will
pledging thousands of donations in just 3 days, total- talking about your fundraiser. Post about your fund-
ing nearly $38,000. In fact, Magnet nurses exceeded raiser on your Facebook page and add a personalized
the Foundation’s challenge to match donations by note about why nursing and nurses matter to you.
two sponsors: Catholic Health Initiatives, which do-
nated $15,000, and Stryker, which donated $10,000. Donations will be used to help nurses have greater
influence in policy, research, practice, and the com-
You can support this effort through February 1: munity.
Text NURSE to 20222 for a $10.00 contribution or Learn more about the Foundation and its programs
Text MAGNET to 20222 for a $25.00 contribution. at givetonursing.org.
34 American Nurse Today Volume 14, Number 1
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